Coronavirus disease 2019 and pityriasis rosea: A review of the immunological connection

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is characterized by the activation of a cytokine storm derived from an excess release of cytokine (interleukin [IL]‐6, interferon [IFN] I, C‐X‐C motif chemokine ligand [CXCL]10, tumor necrosis factor [TNF]‐α, macrophage inflammatory protein [MIP]1) due to an uncontrolled immune activation. There has been a fivefold increase in the number of cases of pityriasis rosea during the SARS‐CoV‐2 pandemic. Using the keywords “pityriasis” and “COVID‐19”, we carried out a PubMed search, including all articles in the English language published until November 2021. We aimed to investigate the possible connection between SARS‐CoV‐2 and pityriasis rosea (PR). Pityriasis could be considered an immunological disease due to the involvement of cytokines and chemokines. Our analysis yielded 65 articles of which 53 were not considered; the others (n = 12) concerning the association between PR and COVID‐19 were included in our study. We suggest two mechanisms underlying the involvement of the skin in viral infections: (i) viruses directly affecting the skin and/or inducing host immune response thus causing cutaneous manifestations; and (ii) viruses as a possible inducer of the reactivation of another virus. The first mechanism is probably related to a release of pro‐inflammatory cytokine and infection‐related biomarkers; in the second, several pathways could be involved in the reactivation of other latent viruses (human herpesviruses 6 and 7), such as a cytokine–cytokine receptor interaction, the Janus kinase–signal transducer and activator of transcription signaling pathway, and the IL‐17 signaling pathway. We thus believe that a cytokine storm could be directly or indirectly responsible for a cutaneous manifestation. More investigations are needed to find specific pathways involved and thus confirm our speculations.

COVID-19-associated parotitis and sublingual gland sialadenitis

“…Another thought is that sialadenitis may be caused by the systemic immune-inflammatory response to the SARS-CoV-2 infection. SARS-CoV-2 is known to cause cytokine storm derived from an excess release of cytokines, which leads to cytokine release syndrome 22. It is characterised by a rise of proinflammatory cytokines such as interleukin (IL)-2, IL-6, IL-10 and interferon-γ in the lung or in the bloodstream, from which the salivary glands are affected.…”

Cutaneous Manifestation in COVID-19: A Lesson Over 2 Years Into the Pandemic

“…There have been several reports of patients with COVID-19 having unusual skin eruptions such as acrodynia, 112 dyshidrosislike lesions, 112 periorbital erythema, 131 eyelid dermatitis, 36,80 skin rash resembling symmetrical drug-related intertriginous and flexural exanthema, 31 mottling, 79 erythema nodosum-like lesions, 56,57,60,61,64,67,77,81,82,88,90,102,103,138 cutaneous hyperesthesia, 13 fixed erythema, 65 facial edema, 64 dermatomyositis, 90 ecchymoses, 64 erythema pernio-like, 135 erythema nodosumlike Sweet's syndrome, 14 and follicular eruption. 142…”

“…Globally, cutaneous manifestations of COVID-19 were reported in cases from Asia including China, 9,36,47, Thailand, 76,77 Iran, 12,61,[78][79][80][81] Indonesia, 19,46,60,67,82,142 Malaysia, 60 Qatar, 77 India, 83 Turkey, 14,[84][85][86] and Kuwait; 87 from Africa including Morocco 20,88 Tunisia, 88 and Egypt; 89 from Europe including Austria, 90 Italy, 10,12,15,18,21,24,25,[32][33][34][35]43,52,53,57,65,69,75,[91][92][93]…”